Pharmacy Network Compliance Analyst

Hispanic Alliance for Career Enhancement; Concord (NH); On-site; USD 43,888 - 102,081; Full time

Benefits offered by this job

Great benefits

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations. This role requires a detail-oriented professional capable of managing multiple priorities and delivering accurate findings.

You will conduct outreach to network pharmacies, analyze claims data and adjudication results, coordinate with Sales, Account Management and other internal teams, and prepare written responses for plan sponsors and stakeholders.

Qualifications

• 3+ years of retail pharmacy experience.
• 2+ years of claims adjudication research experience.
• 2+ years of Microsoft Office applications (Excel, Outlook, Word).
• Bachelor's degree required.

Responsibilities

• Investigate and resolve pharmacy contract non-compliance allegations, including complex and sensitive cases.
• Conduct outreach to pharmacies to gather information and address identified issues.
• Analyze claims data and adjudication results to support findings and recommendations.
• Partner with Sales, Account Management, and other internal teams to coordinate resolution efforts.
• Prepare detailed written responses for plan sponsors, participants, and internal stakeholders.
• Address and resolve customer concerns related to network pharmacy performance.
• Maintain thorough documentation of investigations and outcomes.
• Manage multiple cases simultaneously while meeting deadlines and maintaining accuracy.

Skills

Retail pharmacy experience

Claims adjudication research

Microsoft Office

Education

Bachelor's degree

Tools

Pharmacy benefit management systems

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations. This role requires a detail-oriented professional capable of managing multiple priorities and delivering accurate findings.

You will conduct outreach to network pharmacies, analyze claims data and adjudication results, coordinate with Sales, Account Management and other internal teams, and prepare written responses for plan sponsors and stakeholders.